- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.68 / $272.06 / $354.56
| Professional | | $252.68 | $272.06 | $354.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $252.00 / $252.00 / $252.00
| Facility | | $252.00 | $252.00 | $252.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.00 / $531.00 / $803.00
| Professional | | $494.00 | $531.00 | $803.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.17 / $505.36 / $781.68
| Professional | | $321.17 | $505.36 | $781.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $293.00 / $3,239.00
| Facility | | $293.00 | $293.00 | $3,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.64 / $523.09 / $820.31
| Professional | | $277.64 | $523.09 | $820.31 |